Provider Demographics
NPI:1982827259
Name:SUCHY, KEITH WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:WILLIAM
Last Name:SUCHY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HIGHRIDGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-3456
Mailing Address - Country:US
Mailing Address - Phone:708-562-4474
Mailing Address - Fax:708-562-4535
Practice Address - Street 1:1200 HIGHRIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-3456
Practice Address - Country:US
Practice Address - Phone:708-562-4474
Practice Address - Fax:708-562-4535
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice